The Freedom of Continuous Vision with Silicone Hydrogels

Brian Tompkins. BSc(hons) FCOptom.

Brian is an experienced independent practitioner in his Victorian house-practice in Northampton, UK. His practice was a finalist in the 1999 Optician, Eyecare Practice of the Year Awards. His main interests include contact lenses, children's reading and learning difficulties.

He is proactive in fitting all types of contact lenses and is keen on imaging and video capture for enhanced patient education. He was given the accolade as ''The Best Clinical Photographer in the World Today'' by Prof Nathan Efron at the BCLA 2001 Conference.

Recently appointed Clinical Consultant to Cibavision, his work in contact lenses has included clinical trials with Eurolens Research and Visioncare Research Ltd. He is also an advisory panel member for Monoptica and a number of international contact lens companies.

Brian runs lectures and workshops for practitioners on silicone hydrogel extended wear contact lenses, contact lens problem solving and multifocal contact lenses, all based on real life experience in the consulting room, illustrated using high quality images and video.

After several months with this new lens wear regimen, RJ was still experiencing symptoms of discomfort and redness. Slit lamp examination showed grade 2.5 to 3 bulbar injection using the Efron scale and classic blink related 3 & 9 o’clock staining (Figure 1) .

In an effort to reduce symptoms and improve convenience, RJ was trial fitted with a silicone hydrogel lens (R -8.50, L -9.00) for 30-nights continuous wear. These lenses gave an immediate improvement in comfort and RJ achieved 16 hours of continuous wear time - symptom free with no difficulty. Bulbar injection reduced to 1.00 using the Efron Scale (Figure 2) and there was no staining.

Figure 1: Bulbar and limbal conjunctival injection with previous RGP in situ - click to enlarge	Figure 2: Reduced bulbar and limbal conjunctival injection with silicone hydrogel lenses in situ - click to enlarge

RJ established a pattern of 30 nights continuous wear with no problems apart from a tendency for ''Jelly Bumps'' observed on the lenses at the end of the month (Figure 3). He was advised to do a “rub and rinse” on a regular basis to clean the lens surfaces (Figure 4) and to use rewetting drops as needed.

Figure 3:“Jelly Bump” deposition on a worn silicone hydrogel lens - click to enlarge	Figure 4: Surface lipid deposition on a worn silicone hydrogel lens - click to enlarge

The silicone hydrogels gave a binocular VA of 6/5 and over refraction of +0.75/-1.50x20 D 6/5 in the right eye and -0.50 DS 6/5 (maximum power available –9.00 D) in the left eye. RJ still had to use “top up” spectacles for night driving and critical vision, but his spectacles became less essential when he was fitted with higher power silicone hydrogels.

Before silicone hydrogels were available, the only option for RGP patients such as RJ with chronic discomfort was a cumbersome wear regimen involving three vision correction devices. Although RJ persisted for some time with RGPs to maintain best visual acuity throughout the day, the enormous freedom of “Continuous Vision” with silicone hydrogels far outweighed the improved vision he experienced with rigid lenses. Once RJ experienced continuous wear, he no longer felt that best visual acuity throughout the day was essential and felt it was no problem to use occasional spectacles that looked ''normal'' to improve his critical vision. The added convenience of 24 hour vision with silicone hydrogels also became an unexpected advantage that allowed him to enjoy caring for his new baby.